The Relationship Between Gait Disorder And Cognitive Impai-rment In Patients With Leukoaraiosis

Background and Objective With the development of economy and the improvement of people's living standard,China has gradually entered the aging society.Leukoaraiosis(LA),as an important type of subcortical ischemic vascular disease(SIVD),has been paid more and more attention to the harm of the physical and mental health and the quality of life of the elderly.The onset of LA is insidious,due to the combination of many cerebrovascular disease risk factors,it is easy to be covered by other Symptoms of related diseases,so,it's not easy to cause the patient and the family member's vigilance.A large number of studies have shown that LA patients with gait disorders and cognitive impairment,and there are reports that the gait disorder is an early manifestation of many neurological diseases,often indicates the occurrence and development of disease.Even in healthy elderly,it is also an independent risk factor,which is highly suggestive of cognitive decline or dementia.The aim of this study was to reveal the characteristics of gait disturbance and cognitive impairment,to explore the relationship between them,and to explore its clinical significance,through the measurement of spatiotemporal parameters of gait and clinical evaluation of cognition in patients with LA.Materials and methods 42 patients with LA by MRI were chosen as experimental group(LA group),and 13 normal elderly people without LA as the normal control group(NC group).According to the MRI scan appearances,subjects in LA group were graded into 3 subgroups as mild(LA1),moderate(LA2),severe(LA3)by the rating scale of Wahlund.All of the 55 chosen objects accepted the Neuropsychological assessment and the gait analysis.The Mini-mental state Examination(MMSE)and the Cambridge Cognitive Examination-Chinese Version(CAMCOG-C)were used in the Neuropsychological assessment.Gait analysis contained the Timed up and go test(TUG)and the P-WALK panel-pressure test system(produced by BTS company,Italy)which can accurately measure the subjects' step length,stride length,stride width,step frequency,walking velocity,single support phase,double support phase,cycle time and so on.Contrast the cognitive function and the spatiotemporal parameters of gait between LA group and NC group,LA's subgroups and the NC group,then select the significant difference index to do correlation and multiple regression analysis.Results There was no significant difference in age,gender and education level(P>0.05),between the LA group and the NC group,as well as the LA's subgroups and the NC group,indicate that they are comparable in general information.Compared to the NC group,MMSE and CAMCOG scores were significantly lower in LA group(P<0.05).In comparison with the NC group,the LA group showed longer TUG,shorter step length and stride width,slower walking velocity,the differences were statistically significant(P<0.05).Compared the subgroups of LA with the NC group,MMSE and CAMCOG scores of LA patients were lower with the increasing of their LA degree,the difference was statistically significant among the four groups(P<0.05).In the gait parameters,as the LA patients,the TUG of them were prolonged,the step length as well as the stride width were shortened,the walking velocity became lower with the increasing of their LA degree.However,the stride width and the step frequency increases obviously in the LA3 group,the difference was statistically significant among the four groups.According to the correlation analysis of LA patients,authors found that the TUG had a negative correlation with the MMSE and CAMCOG scores(r=-0.399,P<0.01;r=-0.404,P<0.01),also with memory(r=-0.321,P<0.05),and praxis scores(r=-0.433,P<0.01)in CAMCOG-C.Walking velocity had a positive correlation with the MMSE and CAMCOG scores(r=0.409,P<0.01;r=0.308,P<0.05),also with praxis scores(r=0.535,P<0.01)in CAMCOG-C.After adjusting the grade of LA,Multiple regression analysis revealed that there was no correlation between gait parameters and cognition impairment.Conclusions LA patients have abnormal spatio-temporal gait parameters in walking,and the walking velocity was the most significant,slow walking can be used as an independent predictor of LA risk.Gait disorders in LA patients were related to the severity of LA,and to the cognitive impairment,especially executive function.In the clinical diagnosis and treatment process,more attention shoud be pay to the elderly paitients,particularly,who had gait disorders with risk factors of cerebrovascular disease.Application of intelligent rehabilitation and drug treatment shoud apply in time to delay the progress of disease and improve quality of life in these patients.